Are drug therapies effective in treating Bell's palsy?

Early use of corticosteroid therapy results in less autonomic synkinesis and possibly improved rates of recovery in adults (strength of recommendation: C); there is no proven benefit in children (SOR: B). Adding acyclovir (Zovirax) to prednisone therapy may improve recovery rates compared with prednisone alone (SOR: C). The results of 1 nonblinded study indicate that intramuscular methylcobalamin (vitamin B12) used alone or in combination with prednisone may shorten time to recovery (SOR: C)

What is the best duration of steroid therapy for contact dermatitis (rhus)?

Scant evidence exists for the best duration of steroid therapy for contact dermatitis due to plants (rhus). Review articles recommend 10 to 21 days of treatment with topical or oral corticosteroids for moderate to severe contact dermatitis due to plants (strength of recommendation [SOR]: C, based on review articles). The primary reason given for the duration of 2 to 3 weeks is to prevent rebound dermatitis

Does neonatal circumcision decrease morbidity?

Evidence suggests that neonatal circumcision decreases the incidence of childhood urinary tract infections, phimosis, paraphimosis, balanitis and other genital dermatoses, invasive penile cancer, and the sexually transmitted diseases human papilloma virus (HPV) and HIV (strength of recommendation [SOR]: B, based on case control and cohort studies). The benefits of decreased incidence of HPV and HIV infections go beyond the index patient and have public health implications on the transmission of these diseases (SOR: B). Further, a decrease in HPV incidence and transmission may lead to a lower incidence of cervical cancer (SOR: B). While there appears to be some evidence for reduced morbidity with routine circumcision, decisions regarding routine neonatal circumcision requires balancing risks and benefits of the procedure with the alternatives in the context of social, familial, and religious beliefs

When should COX-2 selective NSAIDs be used for osteoarthritis and rheumatoid arthritis?

Cyclo-oxygenase-2 (COX-2) selective nonsteroidal anti-inflammatory drugs (NSAIDs) are as effective as acetaminophen and nonselective NSAIDs in treating of osteoarthritis, and are equally effective in reducing pain and inflammation and improving of joint function for patients with rheumatoid arthritis, when compared with nonselective NSAIDs. The COX-2 selective NSAIDs also have a better gastrointestinal safety profile in short-term (6-12 month) treatment (strength of recommendation [SOR]: A, based on meta-analysis of randomized controlled trials withpatient-oriented outcomes)

What is the target for low-density lipoprotein cholesterol in patients with heart disease?

Large published randomized controlled trials (RCTs) show that pravastatin and simvastatin are well-tolerated and reduce major coronary events such as death, myocardial infarction, and revascularization by about 25%. The Heart Protection Study suggested this benefit is noted even among individuals with pretreatment low-density lipoprotein (LDL) cholesterol of less than 100 mg/dL. Fluvastatin reduces major coronary events, but current studies are too small to prove reduced overall mortality. The best evidence to date suggests that most patients at significant risk for major coronary events should be given pravastatin or simvastatin 40 mg daily, without concern for the initial or follow-up LDL levels. (Grade of recommendation: A, based on large randomized trials.

Does acyclovir help herpes simplex virus cold sores if treatment is delayed?

When herpes simplex virus (HSV) type 1 lesions are in the papule or vesicle stage, there is no benefit to starting oral acyclovir (strength of recommendation [SOR]: C, based on expert opinion). However, topical acyclovir 5% cream applied 5 times a day decreases pain and the duration of hard crust (SOR: B, extrapolated from randomized controlled trials [RCTs]). If started at the onset of symptoms (during the prodrome stage), acyclovir (400 mg 5 times daily for 5 days) decreases pain and healing time to loss of crust and valacyclovir (2 g twice daily for 1 day) reduces the lesion duration and time to healing and may prevent lesion development (SOR: A, based on RCTs)

What is the best approach to goiter for euthyroid patients?

A detailed history and exam, confirmation of euthyroid status, and imaging when appropriate is the best approach to euthyroid patients with thyroid enlargement in regions where goiters are not endemic. Ultrasound imaging is recommended in any case of diagnostic uncertainty. Evaluate dominant or suspicious nodules further, while diffuse goiters without symptoms require no further evaluation and can be followed clinically (strength of recommendation [SOR]: C, expert opinion)

What levels of cholesterol should be treated for primary prevention?

The levels of cholesterol that should be treated for primary prevention are based on low-density lipoprotein cholesterol (LDL-C) levels of > 100 mg/dL to > 190 mg/dL and vary according to whether the patient's risk is high, moderate, or low. See the table to estimate risk. Grade of recommendation for medication indications: A (on the basis of high-quality randomized controlled trials). Grade of recommendation for lifestyle indications: B (on the basis of extrapolations from randomized controlled trials)

Do acetaminophen and an NSAID combined relieve osteoarthritis pain better than either alone?

Combining nonsteroidal anti-inflammatory drugs (NSAIDs) and acetaminophen for short courses provides more relief of pain in osteoarthritis without an increase in side effects (strength of recommendation [SOR]=B). Combining acetaminophen at 4 g/d with an NSAID can also decrease the daily dose of NSAID required for pain relief, thus reducing the potential risk from higher-dose NSAID therapy (SOR=B). Over the long term, however, this combination may increase the risk of upper gastrointestinal (GI) bleeding more than that conferred by the NSAID alone (SOR=B). If combination therapy is necessary, limiting the dose of acetaminophen to ≤2 g/d minimizes gastrointestinal toxicity. Acetaminophen alone at the lowest dose to provide pain relief is the safest pharmacologic choice for patients with osteoarthritis

In patients with a previous CVA, do antioxidants protect against subsequent stroke?

Most recent randomized controlled clinical trials have not found a benefit in antioxidants (vitamin C, vitamin E, and/or beta-carotene) for preventing cardiovascular disease, including stroke. These recent clinical studies have not confirmed earlier observational studies that suggested a benefit. No studies have assessed only stroke patients and stroke outcomes. (Grade of recommendation: A, based on randomized controlled clinical trials and a systematic review of antioxidants and cardiovascular disease.